Monday, May 4, 2009

Swine Flu Fade or Spread?

The events last week raise questions on who will have access to scarce vaccines if a deadly flu pandemic breaks out. Without a system of fair benefit-sharing in place, developing countries will likely be left without vaccines.

LAST week, the A(H1N1) strain of flu, previously known as “swine flu”, displaced the global financial crisis and various wars as the big headline news around the world.

Early in the week, the World Health Organisation (WHO) warned of the dangers of a rapid spread of the disease. The WHO raised its pandemic alert for A(H1N1) flu to stage five, just short of phase six which would mark a full-scale pandemic.

A WHO official at mid-week said analysis showed it was a new swine influenza virus behaving like a human virus. According to several reports, the virus has a combination of genes from human, swine and bird flu viruses.

What seemed to make this particular flu dangerous is that it can be transmitted human-to-human. The H5N1 avian flu, which mainly affected Asia (especially Indonesia, Thai­land, Vietnam and China), had a higher death rate among those contracting the disease.

But it is transmitted from poultry to humans and not human-to-hu­­man and thus its spread is limited.

The A(H1N1) flu has the potential to spread wider and faster since it can be transmitted by humans. However, except in Mexico, where the flu is said to have originated, the ailment appears to be in a mild form for patients around the world.

Even for Mexico the figures are confusing. The Mexican health autho­rities originally reported a death toll of 176. But last Saturday they said the epidemic was stabilising and re­­vised the number of deaths to 101.

However, other reports say that the number of deaths confirmed for Mexico is only 16, and there is also one death confirmed in the United States, a 21-month-old boy from Mexico who died in Texas.

In Asia, South Korea and Hong Kong had a few cases confirmed, and the big news was the quarantine of hundreds of people who had stayed in a Hong Kong hotel after a Mexican tourist staying there was found to be infected.

The number of persons confirmed with the disease last Saturday was 763 in 18 countries. These comprise 443 in Mexico; 183 in the United States; 85 in Canada; 15 in Spain; 13 in Britain; six in Germany; four in New Zealand; two in Israel, France and South Korea; and one each in Costa Rica, Ireland, Italy, Switzerland, Austria, Hong Kong, Denmark and the Netherlands.

Actions included the closing-down of schools, workplaces and most public places in Mexico for five days, and the closing of 430 schools affecting 245,000 children in 18 states in the United States.

By the end of last week, however, the fears that this was the start of a global pandemic that would cause many thousands or even millions of lives had abated, mainly due to the mildness of the sickness in most of the confirmed cases.

The director of WHO’s London-based World Influenza Centre, Alan Hay, said there were signs the virus was not as virulent as at first feared, and it might not be more virulent than normal seasonal flu infections, according to an article in the Sunday Times of London.

The article adds that experts believe it may be comparable to seasonal flu, which kills up to 550,000 worldwide, and that initial analyses of the DNA sequence of the virus show it is more similar to the seasonal flu virus, and lacks the traits of the 1918 Spanish flu that killed nearly 50 million.

Events this week should show whether this strain of flu will prove to be a dangerous pandemic, or will be only a mild form of flu. Even if it turns out to be the latter, it is wiser to be warned and to be prepared.

There are types of influenza that are easily spread because they are transmitted from human to human but which are mild (like seasonal flu), and types that are deadly but not so easily spread (like the avian flu). The real threat will come when an influenza virus mutates to become a deadly form which is also human-to-hu­­man transmitted and spreads easily.

The A(H1N1) flu outbreak also serves as a reminder that if a deadly pandemic were to develop, there will be a desperate fight over limited supplies of vaccines, in which the developing countries will be at a vast disadvantage. This is because vaccines can be made to protect against a new and particular strain of flu only after this new strain ap­­pears, because parts of the virus are required to make an effective vaccine to counter that particular virus.

There is limited capacity to manufacture the vaccine. The present global manufacturing capacity is estimated at 400 million doses of seasonal flu vaccines a year.

If there is a worldwide pandemic of a new deadly influenza, billions of doses of vaccines will be required, but there are vaccine manufacturers in only a few developed countries, and they will be able to supply only a small portion of what is needed.

Catalysed by the case of the deadly avian flu, developing countries led by Indonesia, Brazil and India have been fighting for reforms in the WHO influenza system so that developing countries (many of which contribute their viruses for research and for manufacturing vaccines) will be assured of a fair share of the vaccines that are to be made globally, and at an affordable price, when pandemics break out.

Without a system of fair benefit-sharing in place, developing countries will likely be left without vaccines, since the companies making them are located in developed countries which would want to ensure the scarce supplies are given to their own people first.

The best solution is to help developing countries develop their own capacity to manufacture the vaccines, so that enough can be available for all that require them when there is an outbreak. This is an urgent matter as millions of lives are at stake.